Control of the Public Health IT Physical Infrastructure: Findings From the 2015 Informatics Capacity and Needs Assessment Survey Kelley Chester, DrPH; Barbara L. Massoudi, MPH, PhD; Gulzar H. Shah, PhD, MStat, MS rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Background: Despite improvements in information technology (IT) infrastructure in public health, there is still much that can be done to improve the adoption of IT in state and local health departments, by better understanding the impact of governance and control structures of physical infrastructure. Objective: To report out the current status of the physical infrastructure control of local health departments (LHDs) and to determine whether there is a significant association between an LHD’s governance status and control of the physical infrastructure components. Design: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials. Participants: A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). Main Outcome Measure(s): Outcome measures included control of LHD physical infrastructure components. Predictors of interest included LHD governance category. Results: The majority of the control of the physical infrastructure components in LHDs resides in external entities. The type of governance structure of the LHD is significantly associated with the control of infrastructure. Conclusions: Additional research is needed to determine best practices in IT governance and control of physical infrastructure for public health. KEY WORDS: governance, informatics, information technology,
infrastructure, local health departments, local public health agencies
● Background Public health departments have made significant improvements to their information technology (IT) infrastructure in recent years. However, there is still much that can be done to improve the adoption of IT in state and local health departments, by better understanding the impact of governance and decision making, or control, structures of physical infrastructure.1-3 Physical infrastructure includes not only hardware and software systems but also the ability to manage, maintain, and secure those systems. Public health adoption and implementation of IT traditionally lags behind our health care counterparts.4 ,5 In 2014, 3 out of 4 hospitals in the United States utilized at least basic electronic health record (EHR) technology.6 Public health has made strides in implementing EHR technology and other data management and analysis tools, but it is still unclear how widespread adoption is.7 These technologies are important to both health care and public health because they support federally funded quality and incentive programs like Meaningful Use.8 IT and EHR technologies play a major role in connecting public health departments not only with health care organizations but also with other public agencies.9 Governance and control structures determine how an organization makes decisions about IT.10 There is no Author Affiliations: C3 Informatics, LLC, Milton, Georgia (Dr Chester); eHealth, Quality Measurement and Health Data Analytics Division, RTI International, Atlanta, Georgia (Dr Massoudi); and Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah). The authors declare no conflicts of interest. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NCND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
J Public Health Management Practice, 2016, 22(6 Supp), S13–S17 C 2016 Wolters Kluwer Health, Inc. All rights reserved. Copyright
Correspondence: Kelley Chester, DrPH, Principal, C3 Informatics, LLC, Milton, GA 30004 ([email protected]). DOI: 10.1097/PHH.0000000000000439
S13
S14 ❘ Journal of Public Health Management and Practice single structure that is considered to be the best practice in either the IT field or within public health.11 There is little research to support best practices in IT governance for public health12 ; however, governance structures are influential in determining how public health programs and agencies perform on a wide range of issues. The degree of centralization or decentralization in decision making also affects governance structures and the ability to standardize across the organization. Developing an IT governance structure should be based on the overarching structure and strategies of the organization as a whole. These strategies must be enterprise-wide to support the ever-increasing frequency and volume of public health data.13,14 In US public health there are many models of governance. Local health departments (LHDs) are sometimes governed by a state health department or at the opposite end of the spectrum may be completely governed at the local level by a local body, like a board of health or the county government. There is also a shared model where governance functions occur at both the state and local levels. IT governance in public health departments often mimics the structure of the overall governance structure, but can also be programmatic in nature. An example of extreme decentralization of IT governance is the situation in which program managers make independent decisions about IT with little or no oversight from a governing committee or central authority. This extreme situation results in duplication of efforts, needless purchases, and a reduced ability to scale.10 Although this is not a common occurrence in public health departments, the typical structure of public health perpetuates programmatic decision making. In contrast to decentralization, an IT governance structure that is built on a centralized model has its own challenges.15 When IT decisions are made by either a centralized or by an external governing body, the needs of programs and local health departments may not be readily understood or considered. This is often looked upon as a “top-down” approach. The purpose of this study is to examine the results of the 2015 Informatics Capacity and Needs Assessment Survey and to report out the current status of the physical infrastructure control of LHDs. This study also seeks to determine whether there is a significant association between an LHD’s governance status and control of the physical infrastructure components.
● Methods Data sampling and design Data were drawn from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by the
Jiann-Ping Hsu College of Public Health at Georgia Southern University in collaboration with National Association of County and City Health Officials’ (NACCHO). This web-based survey had a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design on the basis of 7 population strata: fewer than 25 000, 25 000 to 49 999, 50 000 to 99 999, 100 000 to 249 999, 250 000 to 499 999, 500 000 to 999 999, and 1 000 000 and more. LHDs with larger populations were systematically oversampled to ensure inclusion of sufficient number of large LHDs in the completed surveys. The targeted respondents were informatics staff designated by the LHDs through a mini-survey conducted before the main survey. A structured questionnaire was constructed and pretested with 20 informatics staff. The questionnaire included various measures to examine the current informatics capacity and needs of LHDs. The survey questionnaire was sent via the Qualtrics survey software to the sample of 650 LHDs. The survey remained open for 8 weeks in 2015. A total of 324 completed responses were received with a 50% response rate. Given that only a sample of all LHDs participated in the study and the larger LHDs were oversampled and overrepresented, statistical weights were developed to account for 3 factors: (a) disproportionate response rate by population size (7 population strata, typically used in NACCHO surveys), (b) oversampling of LHDs with larger population sizes, and (c) sampling rather than the census approach.
Measures The survey included a listing of IT-related activities related to the control of local health department physical infrastructure. Respondents were asked to indicate who controlled each of these activities within the LHD. The response categories were “your LHD (within each department or program),” “your LHD (through a central department),” “city/county IT department,” “state health agency,” and “someone else.” Participants were asked to check all that apply if control is shared (Table 1).
Analysis Descriptive analysis was performed to calculate percentages for the categorical variables presented in Table 1. Additional analysis of the infrastructure control variables was carried out on the basis of grouping the control responses into state, local, and shared governance categories. The governance category is determined and assigned on the basis of how each LHD is governed. LHDs that are governed by a state health
Control of the Public Health IT Physical Infrastructure
❘ S15
TABLE 1 ● Descriptive Statistics for the Variables in the Analyses, 2015 (N = 317)a
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Physical Infrastructure Component Hardware allocation or acquisition Software selection Software support Data management Data quality IT system security IT maintenance IT budget allocation
Your LHDb , %
Your LHDc , %
City/County IT Department, %
State Health Agency, %
Someone Else, %
25.4 35.5 20.8 37.8 13.9 12.8 24.1 35.4
32.7 34.6 25.5 30.3 20.3 21.4 35.9 27.6
43.3 39.3 47.6 28.2 51.7 50.1 42.6 25.6
20.1 24.0 20.5 26.8 22.2 19.3 14.5 23.8
5.6 6.7 12.9 4.9 12.0 13.9 4.5 7.6
Abbreviation: LHD, Local health department. a Percentages do not add up to 100%. b Within each department or program. c Through a central department.
department (ie, the LHDs that are units of state health department) fall into the state category. Locally governed LHDs are categorized when a local body, such as the county or local board of health, performs all governance functions and the state health department has no direct authority over the LHD. Shared governance occurs when some governance functions are local whereas others (eg, hiring and firing the LHD director and budget allocation) are under the state health department. We used χ 2 for examining difference in our control of the public health IT physical infrastructure by LHD governance category. All analyses for this study were performed using SPSS version 23.0.
● Results The respondents indicated that the majority of the control of the physical infrastructure components resides in external entities. The control of software support, IT system security, and data quality had a greater proportion of responses pointing toward outside control rather than within the LHD. Table 1 shows that IT security had the least amount of local control, with only 12.8% within each LHD program and 21.4% within a central department of the LHD. There were similar results for control of data quality, with 13.9% within each LHD program and 20.3% within a central department of the LHD. Software support was controlled within each LHD program in 20.8% of the respondents and by a centralized department within the LHD in 25.5%. On the basis of respondents, IT maintenance and software selection were equally controlled within the LHD and external entities. Both of these received similar percentages of within the LHD and either city/county, state, or someone else being in control. Data management and IT budget allocation were physical infrastructure components that were more
commonly controlled by the LHD. IT budget allocation was controlled within each LHD program in 35.4% of the respondents and within a central department of the LHD in 27.6%. There were similar results for data management, with 37.8% within each LHD program and 30.3% within a central department of the LHD. Table 2 shows the results of the χ 2 test to determine association between the LHDs governance category and the response for the control of the physical infrastructure components. Each control variable along with the corresponding control aspect (ie, hardware allocation or acquisition within LHD [through each department or program], hardware allocation or acquisition within LHD [through central department]) was tested for significance at a P value of .05. In all test cases with the exception of software selection through someone else (P = .145), the P value was highly significant. The results indicate that there is a significant association between the governance category (state, local, shared) and the control of physical infrastructure components.
● Discussion and conclusions We studied the control of physical infrastructure components and the possibility of the association of those components to the governance category (state, local, shared) of local health departments. The descriptive statistics showed that the majority of the governance, maintenance, and support of LHDs physical infrastructure is handled either externally or in a decentralized manner. The correlation showed that there is a significant association between an LHD’s governance type or category and the control of the physical infrastructure components. Decentralization is evident in control of infrastructure components such as hardware allocation,
S16 ❘ Journal of Public Health Management and Practice TABLE 2 ● Percentage of LHDs Reporting Control of Physical Infrastructure Components Related to LHD Governance
Category qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq Governance Category Control of Physical Infrastructure Components Hardware allocation or acquisition within LHD (through each department or program) Hardware allocation or acquisition within LHD (through central department) Hardware allocation or acquisition through city or county IT department Hardware allocation or acquisition through state health agency Hardware allocation or acquisition through someone else Software selection within each department or program Software selection within LHD (through central department) Software selection through city or county IT department Software selection through state health agency Software selection through someone else Software support within LHD (through each department or program) Software support within LHD (through central department) Software support through city or county IT department Software support through state health agency Software support through someone else Data management within LHD (through each department or program) Data management within LHD (through central department) Data management through city or county IT department Data management through state health agency Data management through someone else Data quality within LHD (through each department or program) Data quality within LHD (through central department) Data quality through city or county IT department Data quality through state health agency Data quality through someone else IT system security within LHD (through each department or program) IT system security within LHD (through central department) IT system security through city or county IT department IT system security through state health agency IT system security through someone else IT maintenance within LHD (through each department or program) IT maintenance within LHD (through central department) IT maintenance through city or county IT department IT maintenance through state health agency IT maintenance through someone else IT budget allocation within LHD (through each department or program) IT budget allocation within LHD (through central department) IT budget allocation through city or county IT department IT budget allocation through state health agency IT maintenance through someone else
Yes (vs No), % State
Yes (vs No), % Local
Yes (vs No), % Shared
P Value
5.5 20.2 5.0 84.9 0.0 5.5 14.7 5.0 90.0 3.7 1.8 21.9 5.0 82.6 1.8 7.8 13.8 5.0 92.2 0.0 0.0 15.1 5.0 85.3 3.7 1.8 18.3 5.0 85.3 3.7 5.5 13.8 5.0 84.9 0.0 9.6 11.9 3.2 90.0 0.0
24.8 31.9 50.9 10.8 6.5 38.0 34.4 46.2 13.8 7 21.1 22.1 56.2 11.7 14.8 41.1 30.0 32.9 17.5 5.5 14.3 16.7 61.2 12.1 13.4 12.2 17.4 59.2 10.5 15.7 23.3 35.4 50.9 6.4 5.0 37.6 26.8 29.9 14.4 8.8
48.3 50.6 14.8 39.1 3.7 41.7 54.7 13.2 48.8 7.8 35.4 57.2 14.8 37.9 7.8 37.4 48.1 9.9 44.4 3.7 23.0 54.5 14.8 49.4 7.8 28.0 57.2 14.8 33.5 7.8 47.1 59.7 7.8 18.5 3.7 40.7 48.1 9.9 42.8 3.7
Background: Despite improvements in information technology (IT) infrastructure in public health, there is still much that can be done to improve the adoption of IT in state and local health departments, by better understanding the impact of governance and control structures of physical infrastructure. Objective: To report out the current status of the physical infrastructure control of local health departments (LHDs) and to determine whether there is a significant association between an LHD’s governance status and control of the physical infrastructure components. Design: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials. Participants: A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). Main Outcome Measure(s): Outcome measures included control of LHD physical infrastructure components. Predictors of interest included LHD governance category. Results: The majority of the control of the physical infrastructure components in LHDs resides in external entities. The type of governance structure of the LHD is significantly associated with the control of infrastructure. Conclusions: Additional research is needed to determine best practices in IT governance and control of physical infrastructure for public health. KEY WORDS: governance, informatics, information technology,
infrastructure, local health departments, local public health agencies
● Background Public health departments have made significant improvements to their information technology (IT) infrastructure in recent years. However, there is still much that can be done to improve the adoption of IT in state and local health departments, by better understanding the impact of governance and decision making, or control, structures of physical infrastructure.1-3 Physical infrastructure includes not only hardware and software systems but also the ability to manage, maintain, and secure those systems. Public health adoption and implementation of IT traditionally lags behind our health care counterparts.4 ,5 In 2014, 3 out of 4 hospitals in the United States utilized at least basic electronic health record (EHR) technology.6 Public health has made strides in implementing EHR technology and other data management and analysis tools, but it is still unclear how widespread adoption is.7 These technologies are important to both health care and public health because they support federally funded quality and incentive programs like Meaningful Use.8 IT and EHR technologies play a major role in connecting public health departments not only with health care organizations but also with other public agencies.9 Governance and control structures determine how an organization makes decisions about IT.10 There is no Author Affiliations: C3 Informatics, LLC, Milton, Georgia (Dr Chester); eHealth, Quality Measurement and Health Data Analytics Division, RTI International, Atlanta, Georgia (Dr Massoudi); and Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah). The authors declare no conflicts of interest. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NCND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
J Public Health Management Practice, 2016, 22(6 Supp), S13–S17 C 2016 Wolters Kluwer Health, Inc. All rights reserved. Copyright
Correspondence: Kelley Chester, DrPH, Principal, C3 Informatics, LLC, Milton, GA 30004 ([email protected]). DOI: 10.1097/PHH.0000000000000439
S13
S14 ❘ Journal of Public Health Management and Practice single structure that is considered to be the best practice in either the IT field or within public health.11 There is little research to support best practices in IT governance for public health12 ; however, governance structures are influential in determining how public health programs and agencies perform on a wide range of issues. The degree of centralization or decentralization in decision making also affects governance structures and the ability to standardize across the organization. Developing an IT governance structure should be based on the overarching structure and strategies of the organization as a whole. These strategies must be enterprise-wide to support the ever-increasing frequency and volume of public health data.13,14 In US public health there are many models of governance. Local health departments (LHDs) are sometimes governed by a state health department or at the opposite end of the spectrum may be completely governed at the local level by a local body, like a board of health or the county government. There is also a shared model where governance functions occur at both the state and local levels. IT governance in public health departments often mimics the structure of the overall governance structure, but can also be programmatic in nature. An example of extreme decentralization of IT governance is the situation in which program managers make independent decisions about IT with little or no oversight from a governing committee or central authority. This extreme situation results in duplication of efforts, needless purchases, and a reduced ability to scale.10 Although this is not a common occurrence in public health departments, the typical structure of public health perpetuates programmatic decision making. In contrast to decentralization, an IT governance structure that is built on a centralized model has its own challenges.15 When IT decisions are made by either a centralized or by an external governing body, the needs of programs and local health departments may not be readily understood or considered. This is often looked upon as a “top-down” approach. The purpose of this study is to examine the results of the 2015 Informatics Capacity and Needs Assessment Survey and to report out the current status of the physical infrastructure control of LHDs. This study also seeks to determine whether there is a significant association between an LHD’s governance status and control of the physical infrastructure components.
● Methods Data sampling and design Data were drawn from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by the
Jiann-Ping Hsu College of Public Health at Georgia Southern University in collaboration with National Association of County and City Health Officials’ (NACCHO). This web-based survey had a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design on the basis of 7 population strata: fewer than 25 000, 25 000 to 49 999, 50 000 to 99 999, 100 000 to 249 999, 250 000 to 499 999, 500 000 to 999 999, and 1 000 000 and more. LHDs with larger populations were systematically oversampled to ensure inclusion of sufficient number of large LHDs in the completed surveys. The targeted respondents were informatics staff designated by the LHDs through a mini-survey conducted before the main survey. A structured questionnaire was constructed and pretested with 20 informatics staff. The questionnaire included various measures to examine the current informatics capacity and needs of LHDs. The survey questionnaire was sent via the Qualtrics survey software to the sample of 650 LHDs. The survey remained open for 8 weeks in 2015. A total of 324 completed responses were received with a 50% response rate. Given that only a sample of all LHDs participated in the study and the larger LHDs were oversampled and overrepresented, statistical weights were developed to account for 3 factors: (a) disproportionate response rate by population size (7 population strata, typically used in NACCHO surveys), (b) oversampling of LHDs with larger population sizes, and (c) sampling rather than the census approach.
Measures The survey included a listing of IT-related activities related to the control of local health department physical infrastructure. Respondents were asked to indicate who controlled each of these activities within the LHD. The response categories were “your LHD (within each department or program),” “your LHD (through a central department),” “city/county IT department,” “state health agency,” and “someone else.” Participants were asked to check all that apply if control is shared (Table 1).
Analysis Descriptive analysis was performed to calculate percentages for the categorical variables presented in Table 1. Additional analysis of the infrastructure control variables was carried out on the basis of grouping the control responses into state, local, and shared governance categories. The governance category is determined and assigned on the basis of how each LHD is governed. LHDs that are governed by a state health
Control of the Public Health IT Physical Infrastructure
❘ S15
TABLE 1 ● Descriptive Statistics for the Variables in the Analyses, 2015 (N = 317)a
qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Physical Infrastructure Component Hardware allocation or acquisition Software selection Software support Data management Data quality IT system security IT maintenance IT budget allocation
Your LHDb , %
Your LHDc , %
City/County IT Department, %
State Health Agency, %
Someone Else, %
25.4 35.5 20.8 37.8 13.9 12.8 24.1 35.4
32.7 34.6 25.5 30.3 20.3 21.4 35.9 27.6
43.3 39.3 47.6 28.2 51.7 50.1 42.6 25.6
20.1 24.0 20.5 26.8 22.2 19.3 14.5 23.8
5.6 6.7 12.9 4.9 12.0 13.9 4.5 7.6
Abbreviation: LHD, Local health department. a Percentages do not add up to 100%. b Within each department or program. c Through a central department.
department (ie, the LHDs that are units of state health department) fall into the state category. Locally governed LHDs are categorized when a local body, such as the county or local board of health, performs all governance functions and the state health department has no direct authority over the LHD. Shared governance occurs when some governance functions are local whereas others (eg, hiring and firing the LHD director and budget allocation) are under the state health department. We used χ 2 for examining difference in our control of the public health IT physical infrastructure by LHD governance category. All analyses for this study were performed using SPSS version 23.0.
● Results The respondents indicated that the majority of the control of the physical infrastructure components resides in external entities. The control of software support, IT system security, and data quality had a greater proportion of responses pointing toward outside control rather than within the LHD. Table 1 shows that IT security had the least amount of local control, with only 12.8% within each LHD program and 21.4% within a central department of the LHD. There were similar results for control of data quality, with 13.9% within each LHD program and 20.3% within a central department of the LHD. Software support was controlled within each LHD program in 20.8% of the respondents and by a centralized department within the LHD in 25.5%. On the basis of respondents, IT maintenance and software selection were equally controlled within the LHD and external entities. Both of these received similar percentages of within the LHD and either city/county, state, or someone else being in control. Data management and IT budget allocation were physical infrastructure components that were more
commonly controlled by the LHD. IT budget allocation was controlled within each LHD program in 35.4% of the respondents and within a central department of the LHD in 27.6%. There were similar results for data management, with 37.8% within each LHD program and 30.3% within a central department of the LHD. Table 2 shows the results of the χ 2 test to determine association between the LHDs governance category and the response for the control of the physical infrastructure components. Each control variable along with the corresponding control aspect (ie, hardware allocation or acquisition within LHD [through each department or program], hardware allocation or acquisition within LHD [through central department]) was tested for significance at a P value of .05. In all test cases with the exception of software selection through someone else (P = .145), the P value was highly significant. The results indicate that there is a significant association between the governance category (state, local, shared) and the control of physical infrastructure components.
● Discussion and conclusions We studied the control of physical infrastructure components and the possibility of the association of those components to the governance category (state, local, shared) of local health departments. The descriptive statistics showed that the majority of the governance, maintenance, and support of LHDs physical infrastructure is handled either externally or in a decentralized manner. The correlation showed that there is a significant association between an LHD’s governance type or category and the control of the physical infrastructure components. Decentralization is evident in control of infrastructure components such as hardware allocation,
S16 ❘ Journal of Public Health Management and Practice TABLE 2 ● Percentage of LHDs Reporting Control of Physical Infrastructure Components Related to LHD Governance
Category qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq Governance Category Control of Physical Infrastructure Components Hardware allocation or acquisition within LHD (through each department or program) Hardware allocation or acquisition within LHD (through central department) Hardware allocation or acquisition through city or county IT department Hardware allocation or acquisition through state health agency Hardware allocation or acquisition through someone else Software selection within each department or program Software selection within LHD (through central department) Software selection through city or county IT department Software selection through state health agency Software selection through someone else Software support within LHD (through each department or program) Software support within LHD (through central department) Software support through city or county IT department Software support through state health agency Software support through someone else Data management within LHD (through each department or program) Data management within LHD (through central department) Data management through city or county IT department Data management through state health agency Data management through someone else Data quality within LHD (through each department or program) Data quality within LHD (through central department) Data quality through city or county IT department Data quality through state health agency Data quality through someone else IT system security within LHD (through each department or program) IT system security within LHD (through central department) IT system security through city or county IT department IT system security through state health agency IT system security through someone else IT maintenance within LHD (through each department or program) IT maintenance within LHD (through central department) IT maintenance through city or county IT department IT maintenance through state health agency IT maintenance through someone else IT budget allocation within LHD (through each department or program) IT budget allocation within LHD (through central department) IT budget allocation through city or county IT department IT budget allocation through state health agency IT maintenance through someone else
Yes (vs No), % State
Yes (vs No), % Local
Yes (vs No), % Shared
P Value
5.5 20.2 5.0 84.9 0.0 5.5 14.7 5.0 90.0 3.7 1.8 21.9 5.0 82.6 1.8 7.8 13.8 5.0 92.2 0.0 0.0 15.1 5.0 85.3 3.7 1.8 18.3 5.0 85.3 3.7 5.5 13.8 5.0 84.9 0.0 9.6 11.9 3.2 90.0 0.0
24.8 31.9 50.9 10.8 6.5 38.0 34.4 46.2 13.8 7 21.1 22.1 56.2 11.7 14.8 41.1 30.0 32.9 17.5 5.5 14.3 16.7 61.2 12.1 13.4 12.2 17.4 59.2 10.5 15.7 23.3 35.4 50.9 6.4 5.0 37.6 26.8 29.9 14.4 8.8
48.3 50.6 14.8 39.1 3.7 41.7 54.7 13.2 48.8 7.8 35.4 57.2 14.8 37.9 7.8 37.4 48.1 9.9 44.4 3.7 23.0 54.5 14.8 49.4 7.8 28.0 57.2 14.8 33.5 7.8 47.1 59.7 7.8 18.5 3.7 40.7 48.1 9.9 42.8 3.7
